Why You Need Good Sleep — and How to Get It — if You Have Bipolar Disorder

And one study found that insomnia and sleepiness are particularly prevalent in people with bipolar disorder, even when not experiencing a manic or depressive episode. It also showed that treating insomnia or sleepiness during different mood states could improve quality of life.

“Even if someone makes do on little sleep, it can have repercussions, such as increased moodiness, depression, worry, difficulty concentrating, and even higher risk for accidental death in a worst-case scenario,” says Sanam Hafeez, PsyD, a licensed psychologist in Queens, New York, and director of Comprehensive Consultation Psychological Services, a center for neuropsychological, psychiatric, and educational difficulties.

So, if you’re having sleep issues, tell your doctor as soon as possible, advises Gonzalo Laje, MD, director of Washington Behavioral Medicine Associates in Chevy Chase, Maryland.

Bipolar Disorder Can Make You Feel Like You Don’t Need Sleep

The sleep issues that people with bipolar disorder experience can vary. For example, some may find they need less sleep, while others may feel they can’t get enough sleep, per the American Psychiatric Association.

If you are experiencing the highs of bipolar disorder (mania), you may suddenly need dramatically fewer hours of sleep to stay alert and energized. For example, if you regularly sleep eight hours, you may feel you’re rested on as little as four hours of sleep.

This is because mania can be so exciting or stimulating that you don’t feel tired even while running on much less sleep than normal, Dr. Hafeez explains.

“Difficulties falling asleep, on the other hand, are events more likely to happen when patients are undergoing a depressive episode, [or the lows of bipolar disorder],” says Dr. Laje. “For example, some patients try to sleep but can’t fall asleep, or they have disrupted sleep, such as waking up in the middle of the night and not being able to go back to sleep or waking up too early.”

Here are some sleep problems common among people with bipolar disorder, according to the Frontiers in Psychiatry review.

• Insomnia is marked by a having a hard time falling asleep, difficulty staying asleep throughout the night, waking up too early in the morning, or a combination of these.
• Obstructive sleep apnea causes a person’s breathing to become shallow or very briefly stop altogether while asleep, often leading to chronic daytime sleepiness.
• Sleep talking and sleepwalking are both types of parasomnia, or abnormal behavior during sleep. Sleep talking is harmless. While sleepwalking generally is safe, as well, it can sometimes lead to injury.
• Sleep phase delay syndrome causes trouble falling asleep, resulting in sleep that’s delayed by at least two hours beyond what’s viewed as an acceptable bedtime, per Stanford Medicine. This then makes it harder to wake up on time.
• Excessive daytime sleepiness due to poor-quality sleep at night can mean trouble staying alert and making decisions during the day.

Lack of Sleep Can Trigger Bipolar Symptoms

In the same way that bipolar disorder can cause sleep issues, the reverse can also be true: Lack of sleep can exacerbate bipolar symptoms. In fact, for many with bipolar disorder, sleep issues are the most common cue that a manic episode is looming, says Hafeez.

According to a study of more than 3,100 people with bipolar disorder, sleep loss was found to trigger high mood episodes (mania), especially among women and participants with bipolar 1, specifically.

Shift work is one situation that the authors noted could predispose someone to high mood episodes. Hafeez adds two others: “Jet lag, as well as sleep deprivation, can trigger hypomanic or manic periods for some with this disorder.”

Expert-Backed Recommendations for Better Sleep

Research has shown a link between bipolar disorder and sleep, such as the fact that bipolar disorder can have a significant impact on how much and how well you sleep, and lack of sleep can increase your risk of manic or depressive episodes. Given that, it’s clear addressing sleep issues is an important part of managing bipolar disorder.

Here are some strategies from experts on how to get the sleep you need.

1. Seek Professional Help

As with all mood disorders, treatment by a mental health professional can improve your symptoms, including sleep issues, says Dr. Martin.

Also consider scheduling an appointment with a doctor at an accredited sleep disorders center near you. “There are many board-certified sleep medicine physicians who are neurologists and psychiatrists, who may be especially well suited to help,” she says. Organizations such as AASM have search tools to help you find a sleep center near you.

“In addition, if people with bipolar disorder struggle with insomnia even when their mood symptoms are stable, they can still benefit from direct treatment of insomnia by a behavioral sleep medicine specialist like a clinical sleep psychologist,” says Martin. Cognitive behavioral therapy, which focuses on replacing unhelpful thinking and behavior patterns with healthier ones, is commonly used to treat insomnia and can be safely adapted for people with bipolar disorder, she says.

2. Ask Your Doctor for Sleep-Friendly Tweaks to Your Bipolar Medications

Medications used to treat bipolar disorder may cause sleep issues as a side effect, Martin says. They may also interact with other medications or supplements you’re using and cause sleep problems.

Ask your doctor if you should take your medications at specific times of day to minimize their impact on your sleep. For instance, Martin says, if a medication makes you feel drowsy, take it at night rather than during the day.

Sometimes, adjustments to the types or doses of medication can help. But always talk to your doctor before making any changes to your medication regimen, to avoid worsening your bipolar symptoms.

3. Set a Bedtime Schedule and Make It Nonnegotiable

Going to bed at the same time each night and waking up at the same time each morning as consistently as possible will help you maintain your circadian rhythm, the internal clock that regulates your sleep-wake cycle. This, in turn, will improve your shot at a good night’s rest and reduce your risk of mood episodes down the road, says Martin.

“People with bipolar disorder should be particularly careful to avoid periods of sleep deprivation, as this is one factor that can contribute to mania,” she says.

4. Keep a Sleep Diary

Keep track of your sleep habits and symptoms over time, so you and your doctor can detect patterns that may be preventing you from getting a good night’s sleep. Hafeez suggests using a sleep diary each morning to jot down:

• How long it took you to fall asleep the previous night
• How many times you woke up during the night
• How long you stayed asleep
• Any medications you took to help you sleep
• Whether you had caffeine or alcohol prior to bedtime
• Whether you exercised during the day, including what time you exercised and for how long

5. Steer Clear of Stimulating Activities or Substances Near Bedtime

Use the last hour or two before bed to prepare your body for sleep. This means avoiding bright lights, cell phones, and stimulating activities, says Hafeez. And before you turn in for the night, “Place your cell phone face down, so the light is not emitted from it,” she says.

And although regular exercise is helpful for managing bipolar symptoms, exercising too close to bedtime can be stimulating and make it difficult to fall asleep, she adds. To avoid this, exercise earlier in the day.

To prepare your body for bedtime, Hafeez suggests that you:

• Avoid caffeine and alcohol late in the day.
• Keep your bedroom as quiet and dark as possible.
• Maintain a room temperature that’s not too cold or hot. According to Cleveland Clinic, a bedroom temperature of 60 to 67 degrees F can deepen sleep.
• Use blackout shades, earplugs, and a sleep mask to block excessive light and noise.
• Play calming background music as you drift off. (To find free tracks, type “calming music for sleep” in Google or another search engine.)
• Nicotine is a stimulant, so if you smoke cigarettes, avoid doing so for the last two hours before you sleep.

6. Try Bright Light Therapy in the Morning

Bright light therapy is often used to manage circadian rhythm disorders and can gradually normalize your sleep patterns, according to Stanford Medicine. While bright light therapy can be helpful for nearly anyone with sleep issues, a study found that it may be especially helpful for people with bipolar disorder.

To get the most out of bright light therapy, experts at Stanford suggest using the device as soon as possible after you wake up in the morning. There are many bright light therapy devices available to purchase. Ask your doctor to recommend the best one for you.